Older lady sitting and talking to clinician

Bladder Cancer

Bladder cancer is the most common cancer of the urinary tract system and starts in the lining of the bladder

It is more common in men than in women and in most cases (75%) it is in the stage of superficial cancer, without having penetrated the bladder wall and without having given distant metastases. When it does not invade the bladder muscle, it is called Non Muscle Invasive Bladder Cancer (NMIBC) (aka Superficial Bladder Cancer). When it invades the bladder muscle, it is called Muscle Invasive Bladder Cancer (MIBC).

The most common symptom of bladder cancer is blood in the urine. Usually the patient himself sees the blood in the urine (visible haematuria) or is discovered the urine examination (non-visible haematuria) without the blood being visible to the naked eye.

The diagnosis of bladder cancer is made by cystoscopy. Cystoscopy is the examination by which a urological instrument, the cystoscope, which carries a camera, enters the bladder from the urethra and allows us to see its interior under direct vision.

Other tests, such as ultrasound, computed tomography, can only give us a suspicion of bladder cancer, which must always be confirmed by cystoscopy.

Treatment depends on the size of your cancer, whether it has spread (the stage), the type you have, what the cancer cells look like (the grade), and your general health

In superficial bladder cancer, or non-muscle invasive bladder cancer, the cancer cells are only in the bladder’s inner lining.

These patients are offered surgery to remove the cancer from their bladder lining. The first step in this direction is the transurethral resection of the bladder tumour. This operation is performed through the urethra without cutting the skin. The tumour is resected and sent for histological examination.

The outcome of the histological examination will determine whether the patient needs further treatment or not. The type and grade of the cancer cells is checked to see if you have low risk, intermediate risk or high risk early bladder cancer. These risk groups describe how likely it is that your cancer will spread or come back after treatment

The treatment you have depends on:

  • The size of your tumour (T stage)
  • What the cells look like under a microscope (grade)
  • How many tumours there are
  • The type of bladder tumour you have
  • Whether you have had treatment in the last year for superficial bladder cancer

The main treatments for superficial bladder cancer are:

  • Surgery -Transurethral resection of Bladder Tumour
  • Chemotherapy into the bladder
  • BCG into the bladder

Low Risk Superficial Bladder Cancer:

If after the Transurethral resection of Bladder Tumour the histology is Low Grade the patient might not need any further treatment or have chemotherapy into the bladder (intravesical chemotherapy)

Intermediate (Moderate) Risk Superficial Bladder Cancer:

If after the Transurethral resection of bladder tumour the histology is Intermediate (Moderate) Risk Superficial Bladder Cancer, usually the patient then has a 6 week course of chemotherapy into your bladder.

High Risk Superficial Bladder Cancer:

If after the transurethral resection of bladder tumour the histology is High Risk Superficial Bladder Cancer the patient will have a second TURBT operation within 2-6 weeks of the first. This is to double check if the bladder cancer has grown.

Further treatment choices. You may have:

  • A course of treatment with the BCG vaccine into the bladder
  • Surgery to remove the bladder (radical cystectomy)

Patients with Muscle Invasive Bladder Cancer (MIBC) are usually offered either a radical cystectomy or radiotherapy. There are other treatments which are less effective.

You need to talk to your specialist doctor and nurse about the risks and benefits of these treatments. They will discuss with you with regards to the stage of your cancer and how likely it is to spread. They will also inform you of how well these treatments have worked for other people, and about the possible side effects.

After any treatment for superficial bladder cancer, your Urologist keeps a close eye in case the cancer comes back.

You have regular cystoscopies for some years. How often you have these depends on your bladder cancer risk group.

What if the bladder cancer comes back?

Despite the efforts of urologists and patients, bladder tumours unfortunately sometimes reappear.

Once new tumours have been identified, the patient should have another transurethral resection check that the cancer is still at an early stage. This is the only way to prevent the spread of the disease.

If it is, you usually have chemotherapy or BCG treatment into the bladder. You then go back to having regular cystoscopies to check your bladder.

Non Muscle Invasive Bladder Cancer (NMIBC) Surgeons
Mr Georgios Papadopolos

Mr Ed Streeter

Mr Sashi Kommu

Mr Adrian Simoes

Mr Issam Ahmed

Consultant Clinical Oncologists
Dr Carys Thomas
Dr Albert Edwards
Dr Rakesh Raman
Dr Patryk Brulinski

The Cancer Care Line

  Contact The Cancer Care Line:  01227 868666

 (Monday to Friday 9am - 5pm, Saturday and Sunday 8am - 4pm)

This is a central helpline for all patients who have come into contact with a Macmillan Clinical Nurse Specialist or the Macmillan Acute Oncology Team. Not all people that are given this number have cancer, some maybe undergoing investigations to rule it out.

The people that answer your calls are not medically trained and in order for them to direct you to correct person/ team, they will ask for some clinical and personal information.

The Macmillan Clinical Nurse Specialists run designated phone clinics, therefore if appropriate you will be booked onto the next available telephone clinic which may not be the same day. 

If the Cancer Care Line Co-ordinator's triage indicates you require urgent clinical advice, you will be put through to the specialist nurse of the day.